title: Parathyroidectomy reduces intradialytic hypotension in hemodialysis patients with secondary hyperparathyroidism.
abstract: BACKGROUND
  Secondary hyperparathyroidism is associated with vascular calcification and arterial stiffness in patients with end-stage renal disease. The aim of this study was to analyze the frequency of intradialytic hypotension (IDH) and cardiovascular function before and after parathyroidectomy (PTX) in maintenance hemodialysis patients.
  
  
  METHODS
  We compared predialytic and intradialytic blood pressure, left and right ventricular ejection fraction (LVEF and RVEF), and cardiothoracic ratio 1 month before PTX, and 6 and 12 months after PTX. IDH was defined as a decrease in systolic blood pressure ≥ 20 mmHg or a decrease in mean arterial pressure ≥ 10 mmHg.
  
  
  RESULTS
  At the time of PTX, the mean age of the patients was 57.4 ± 12.0 years, and the mean dialysis vintage was 12.2 ± 5.8 years. At baseline, 6 months, and 12 months after PTX, the average numbers of sessions disturbed by IDH during 13 dialysis sessions (1 month) were 6.4, 3.9 (p < 0.016 vs. baseline), and 4.0 sessions (p < 0.037 vs. baseline, p = 0.801 vs. 6 months), respectively. LVEF and RVEF were improved significantly after PTX. Furthermore, volume status was also improved, as evidenced by the significantly greater ultrafiltration volume and reduced cardiothoracic ratio.
  
  
  CONCLUSIONS
  Hemodialysis patients with severe secondary hyperparathyroidism are more likely to achieve normotensive and euvolemic status after PTX, probably through improved heart function and reduced IDH episodes.
authors.affiliation: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Shih
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
authors.forename: Wu-Chang
authors.initials: WC
authors.lastname: Yang
authors.forename: Chih-Yu
authors.initials: CY
authors.lastname: Yang
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D007022:Hypotension / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods; D006435:Renal Dialysis / Q000009:adverse effects*